Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation

Int J Cardiovasc Imaging. 2013 Jan;29(1):71-8. doi: 10.1007/s10554-012-0053-1. Epub 2012 Apr 29.

Abstract

The study of left atrial (LA) mechanical function during atrial fibrillation (AFib) can provide valuable information, particularly if such profiling is related to the cavity electrical substrate and conveys prognostic information. To assess if there is any relation between LA mechanical and electrical asynchrony and if such evaluation can be of interest in stratifying AFib patients. 50 patients with persistent AFib who underwent electrical cardioversion (CV) were evaluated with pre-CV atrial electrograms (AEGs). Electrical asynchrony was classified according to Wells' patterns of AEGs, ranging from most organized (I) to most dispersed (III) one. LA mechanical asynchrony was addressed by transthoracic 2D-speckle-tracking echo and quantified according to time-to-peak standard deviation (TP-SD) of wall strains and their peak values (PS) before CV, after 24 h, at 1 month. Pre-CV a linear, inverse relation between TP-SD and PS (p < 0.001) and a direct linear relation between TP-SD and Wells' classes (p = 0.04) were observed. With sinus rhythm TP-SD decreased (p = 0.023) and PS increased (p < 0.001), suggesting improved LA mechanical milieu. A multivariate analysis, testing the effects of baseline variables in predicting post-CV recurrence of AFib, revealed that amount of TP-SD variation pre/24 h post-CV was the only independent predictor at 6 months (p = 0.046). Speckle tracking-derived LA parameters can describe LA wall forces during AFib, categorizing the asynchronous mechanistic profile of AFib that correlates with the degree of the dispersed LA electrical activity. The amount of changes in LA mechanical asynchrony pre/post-CV seems to have prognostic relevance in predicting SR maintenance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy
  • Atrial Function, Left*
  • Biomechanical Phenomena
  • Echocardiography, Doppler, Color
  • Electric Countershock
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Heart Conduction System / physiopathology*
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Severity of Illness Index
  • Treatment Outcome